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Abstract:There is a multitude of instruments for measuring religiosity/spirituality. Many of these questionnaires are used or even were developed in the context of studies about the connection between religiosity/spirituality and health. Thus, it seems crucial to note that measures can focus on quite different components along a hypothetical path between stressors and health. We present an instructive model which helps to identify these different components and allows the categorization of instruments of religiosity/spirituality according to their primary measurement intention: intensity/centrality, resources, needs, coping, and quality of life/well-being. Furthermore, we point out possibilities as to how religiosity and spirituality can be differentiated. We argue that the distinction between religiosity and spirituality is important in countries with a more secular background where a growing number of people identify themselves as "spiritual, but not religious".

If assessment instruments are used to measure efficacy or effectiveness, for example of rehabilitation programmes, they have to be sensitive (or responsive) to change. However, up to now there has been no consensus on what coefficient should be used for this end. Various effect sizes and criterion measures are widely acknowledged; tests of inferential statistics are also still used. The different coefficients may well provide different rank ordering of competitive instruments. Recently, the so-called 'smallest real difference' (SRD) was proposed as a measure of sensitivity to change. In the original formulation, the SRD was defined as the 95% confidence limit of the standard error of measurement (SEM) of the difference scores. Conceptually this is equivalent to what is known as the 'reliable change index' in psychotherapy research. The absolute values of the SEM/SRD indicate measurement error. In our view, this is merely complementary to the reliability concept and not a measure of sensitivity to change. Instead, we suggest using the percentage of patients reaching the SRD criterion to compare the sensitivity to change of competitive instruments. In contrast to other sensitivity-to-change indices, such an approach takes the different reliabilities of competitive assessment instruments explicitly into account.

Within the last few years the relationship between religiousness and psychosocial adjustment has become a subject of increasing interest. However, previous research did not explicitly differentiate between dispositional religious commitment and situation-specific religious coping. The current cross-sectional study investigated the relative power of religious commitment, positive and negative religious coping, and religious commitment x religious coping interactions in the prediction of anxiety. The sample consisted of 167 German breast cancer patients who were assessed during an inpatient rehabilitation programme. Results indicated that positive and negative religious coping were more strongly related to anxiety than dispositional religious commitment. Furthermore, hierarchical regression analysis revealed a religious commitment x negative religious coping interaction. According to this interaction, there seems to be some synergistic effect of high levels of religious commitment and high levels of negative religious coping. In contrast, positive religious coping did not function as a moderator and appeared to be closely related to religious commitment. This may be due to the specific religious-cultural background in Germany.

In Germany, studies in rehabilitation research--in particular evaluation studies and examinations of quality of outcome--have so far mostly been executed according to the uncontrolled one-group pre-post design. Assessment of outcome is usually made by comparing the pre- and post-treatment means of the outcome variables. The pre-post differences are checked, and in case of significance, the results are increasingly presented in form of effect sizes. For this reason, this contribution presents different effect size indices used for the one-group pre-post design--in spite of fundamental doubts which exist in relation to that design due to its limited internal validity. The numerator concerning all effect size indices of the one-group pre-post design is defined as difference between the pre- and post-treatment means, whereas there are different possibilities and recommendations with regard to the denominator and hence the standard deviation that serves as the basis for standardizing the difference of the means. Used above all are standardization oriented towards the standard deviation of the pre-treatment scores, standardization oriented towards the pooled standard deviation of the pre- and post-treatment scores, and standardization oriented towards the standard deviation of the pre-post differences. Two examples are given to demonstrate that the different modes of calculating effect size indices in the one-group pre-post design may lead to very different outcome patterns. Additionally, it is pointed out that effect sizes from the uncontrolled one-group pre-post design generally tend to be higher than effect sizes from studies conducted with control groups. Finally, the pros and cons of the different effect size indices are discussed and recommendations are given.

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